Comments on: Why Obamacare Can’t Work: The Calculation Argument

By: Omar

Omar — Tue, 06 Apr 2010 20:43:25 +0000

Monopsonyies reduce economic well being in the same sense that Monopolies do the same. When vendors submit to excessive pressure from a single buyer to reduce costs often times quality is compromised and/or innovation.
In fact the supreme court has stated that monosponies are detrimental to society. They have extended the Sherman Anti-trust act to these types of companies as well.

You can read the opinion of the court on their decision WEYERHAEUSER CO. v. ROSS-SIMMONS HARDWOODLUMBER
http://www.law.cornell.edu/supct/html/05-381.ZO.html

By: Yes We Can

Yes We Can — Sun, 19 Jul 2009 03:23:12 +0000

“Other countries such as the United Kingdom cannot accomplish it with even very high taxation rates. ”

Well don’t worry, Saint Obama will use very very very high taxation rates on the “rich” so everything will be fine.

And if that doesn’t work, Saint Obama will use ultra hyper super duper high taxation rates.

And if that doesn’t work, Saint Obama will seize the assets of the “rich” to pay for this health care.

And if that doesn’t work, Saint Obama will force doctors to do overtime at gunpoint.

YES WE CAN !!!

By: ganpalou

ganpalou — Sun, 19 Jul 2009 01:32:14 +0000

Yo John: I have heard the argument that the public option will drive out private plans. It is unlikely. The most likely consequence is much uglier. Back in the days when I had a future, I was a boiler and machinery underwriter for a few years. From the inside, I learned that an insurance company can do well with a conservative portfolio and 86% to 92% claims payout. Later, I became a trustee for a health benefit trust. It irritated me that health insurance cos. wanted 65% claims payout year over year. But that doesnt even come close to government cost structures.
When government provides services to willing clients, about 20% gets to the target. HUD is a good example, also education. Fannie Mae and Freddie Mac happen when government tries to be efficient. If the client is unwilling, about 10% gets to the target. Prisons are the best example. The military achieves about 9% of cost getting to the line. I havent tried to track Medicare, Medicaid, but they can’t be hitting much more than 20% actual service payment.

On top of efficiency problems, we have a radical difference in risk of the clientelle. The government plan will continue to service the most disorganized people. They will have a higher disease, disability burden than people who can get to work on time, regularly. This occurs now in emergency rooms, and explains why an ER visit is $11,000. (This figure is old and from California; it may be low). Client “challenges” also contribute to the Medicare, Medicaid costs.

But Medicare, Medicaid have an advantage that may go away. Currently, the retired, the elderly, and the impoverished gravitate toward rural areas because dirt, and therefore housing, is cheaper. Rural areas do not have high dollar medical services available; therefore, those folks just do not use those services. They die from “distance.” A compressed analog occurs in inner cities. Nobody builds hospitals in the ghetto, not even the prisons. And from the emergency room wait, one might as well be on Santa Catalina island. So the “government plan” is unlikely to be attractive or cheap, just slow and overcrowded, kinda like prison health care (which is provided as a “Right”).

The most efficient “private” plans will be the ones which contract with providers who avoid the high risk, high burden clientelle. Kaiser-Permanente is the perfect model. The business models of worker’s comp doctors should be adaptible to achieve the objective, also.

We havent seen the finished fiasco; therefore, it is too early to judge whether it will be more like: 1. The Hawaii model, where a fella either lives on the dole or gets one job for health care, and a second job to live on. or 2. The Canadian model, where you wait for service at home, rather than in the emergency room. (Waiting is free.) or 3. The Austrian model, where basic services are provided, but you better have some financing if you want more than aspirin.

By: newson

newson — Sat, 18 Jul 2009 15:00:41 +0000

excellent point, ganpalou.

By: John

John — Sat, 18 Jul 2009 13:47:49 +0000

Rationing is the inevitable long term conclusion to controlling costs with the public option plan. It is the inescapable result that this plan over time will exceed our national capacity to cover the costs. There is no reason to think otherwise as we have Medicare as our example. Other countries such as the United Kingdom cannot accomplish it with even very high taxation rates.
If the public option becomes available many will move in that direction. Business owners will see this as a lower cost alternative. More and more people will move or be shunted to this option. Providers and hospitals will try to make the balance sheet work by charging more to commercial insurance to offset the decreasing revenue threatening their existence. This will drive up premiums. Private insurers will have the combined problems of access to a reduced pool of individuals and the need to charge higher premiums and ultimately will lead to most potentially leaving the health insurance industry. While the very wealthy may always be able to find alternatives, the middle class will be stuck with no options. Unfortunately many doctors will leave the field as reimbursement falls to low to cover overhead costs. The timing will be problematic as the baby boomer retirement will be reaching peak levels resulting in increased utilization coupled with reduced government tax revenues. This will further encourage access problems. Utilization costs for the public option will climb with the growing number of people covered. Taxes will have to increase greatly to help cover the costs. This will have a further deleterious effect on our economy which is forecasted by most to be fragile for a decade or more. Further economic contraction will only further depress tax revenues and the ability to pay for this program. It will become apparent that the only way to control costs is to limit access to services. There is no existing large scale national plan that does not ration care.
. Competition is the best and only answer here. Clearly the current Medicare model has failed miserably at controlling costs. It is surprising that with the numerous examples of the failures of price controls with commodities no less important than food and energy that we do not take note and foster the power of competition and the free market to help us out of this problem (national energy crisis of the 70′s, California energy crisis of the 90′s, etc). PATIENTS MUST CONTRACT DIRECTLY WITH PHYSICIANS. This is how it used to be done. If price controls were removed we would allow these powerful forces to control costs. We would not see the kind of yearly health care cost increases that have been such a big problem. From an insurance coverage perspective, a base plan that includes very high deductibles that discourages overutilization goes a long way toward cutting costs of the average insurance plan. The patient shops for affordable health care and is covered for any catastrophic events. As a physician myself, a model fostering free competition has some real financial risk but I would much rather have this plan as a patient. We need a plan that allows the patient the choice to have the hip fracture repair rather than to be told by their one and only option, the public option, that they are too old and do not meet the criteria. And if they choose to not have the surgery or choose to not buy the high deductible plan, then at least that is their choice. That will sit better with most Americans versus the government plan telling them that they are not covered when they thought they were.

By: End the Fed

End the Fed — Sat, 18 Jul 2009 12:08:09 +0000

“The best thing that could happen in the US today is for China, Japan, Saudi Arabia and others to cash in their American dollars for gold, oil, real estate etc.”

And why would anybody take those dollars?

“The collapse of the dollar would force the US government to shrink and the war machine to end.”

The military backs the dollar. The dollar is on the bomb standard. It won’t collapse until the military-industrial complex collapses first.

By: Walt D.

Walt D. — Sat, 18 Jul 2009 11:29:06 +0000

Laser Eye surgery is a good example of what happens when you get insurance companies and government out of the way – prices for the procedure went way down and quality went way up.
The insurance model is usually criticized because of “third partying” – I’m not likely to shop around for the best price if someone else is picking up the tab. However, there is a more insidious effect. Insurance companies are regulated by either state of federal agencies. The business model under which insurance companies operate is to set premiums so that they cover the cost of claims plus a markup. Thus we have a perverse model. Insurance companies actually

want

people to make claims since their profitability increases. This is why Jeff Tucker’s viagra is so expensive!

By: ganpalou

ganpalou — Sat, 18 Jul 2009 01:27:35 +0000

There seems to be a lot of passion for closing the barn door after the horse is out. We already have a Supreme Court decision declaring a medical procedure to be a “Right,” something between the doctor and the patient, irrespective of reason or need, and irrespective of ability to pay, with the tab picked up by taxpayers. It is called “Roe vs Wade.” If the “Right” identified under Roe vs Wade is extended under the 14th Amendment, BINGO. I suppose this manufactured Right could be extended medical procedure by medical procedure. The Obama plan is merely a shortcut, like using a computer.

The greater question is whether Americans can do business with each other. The recent, but continuing, financial mess casts serious doubt on this, as do the outsourcing of manufacturing, the importing of foreign labor, technology, food, etc. When we say that health care is too expensive, we are complaining about doing business here in America, that our values are out of balance with our ability to achieve those values. “Too expensive” also applies to government, education and legal services. These things are already mandatory, unless your chest is stainless steel. Why not health care?

Obama is merely applying, at home, the American leverage which is the foundation of the “Pax Americana.” He is proposing to point a gun at everyone, and ordering them to do business, his way. If you dont want to participate, you are subject to go to jail for tax evasion. Gee, that is the same as the bailout money, and “cap and trade.” If we only apply the process at home, we have fascism; if it becomes internationalized, we have the “New World Order.”

The cost, at this point, is sort of irrelevant. The transfer of capital to support our consumer based economy, which has been occurring continuously since LBJ, leaves us with a deficit of $12 trillion in present value of future tax income. I know I cant pay my share. I know my children; they cant pay their share. I have watched my grandchildren; without a miracle, they wont be able to pay their share. I live a sheltered life; I dont know anyone who can pay their share.

And that is the logical fallacy. Even though Obama is “Commander in Chief,” they havent made a gun yet which will enable me to pay what they say I owe. Even if they shoot us all, the fire sale value of all our assets will not equal our liabilities.

Until we see the muzzle flash, I hope you and I can continue to cut a deal where we both walk away happy with the results. It is obvious that there are a ton of folks who cant.

By: greg

greg — Fri, 17 Jul 2009 10:27:18 +0000

Here is a news flash, you want lower healthcare cost, just pay cash. My visit to the hospital and informing them I was going to pay cash for my treatment, I received a 65% discount.

If you want true reform, make everyone have a $5,000 deductable on their heathcare insurance. They will go to the doctor when they really need to and will pay without all the middlemen. This will result in less demand for medical care and will lead to lower prices.

By: Bennet Cecil

Bennet Cecil — Fri, 17 Jul 2009 10:20:44 +0000

When inflation, unemployment and interest rates are above 12%, real change will come to America. The best thing that could happen in the US today is for China, Japan, Saudi Arabia and others to cash in their American dollars for gold, oil, real estate etc. The collapse of the dollar would force the US government to shrink and the war machine to end.

The American people will suffer the consequences of electing presidents Bush and Obama. Americans have chosen the federal government to deliver health, protection, and prosperity.

Wise Americans will move their capital out of the US while they can. Once the dollar collapses all of this nonsense will stop, but will be replaced with chaos. New leaders, new laws and a new currency could allow a fresh start.

By: Christopher

Christopher — Fri, 17 Jul 2009 09:53:40 +0000

I can only imagine what would happen if there was no healthcare insurance. Would prices not drop due to increased competition among MD’s?

The problem is that those who are for the system seem to live under that assumption that they would receive the same quality “end of life” care that they currently cannot afford to pay. The reality is that our tax burden is going to continue to grow as more and more baby boomers move into retirement regardless of whether or not we have a single payer system.

IIRC..I read that under the public/private plan one of the versions of the bill would not allow citizens to obtain private care once the bill is signed into law. You can keep your current provider, but once it’s lost, it’s lost forever.

By: Matt Butt

Matt Butt — Fri, 17 Jul 2009 09:46:27 +0000

Any chance we can have a few of these posts deleted? I don’t think this qualifies as intelligent debate.

By: Obama The Saint God

Obama The Saint God — Fri, 17 Jul 2009 08:09:13 +0000

If Obama planned on sending us to India then his plan on cutting health care costs would work.

I’m sure that India would welcome the medical tourism. This would lower the American health care bill and contribute to enrich India. A win-win situation.

This could help against the current economic crisis.

Tell me, how come a $65,000 hip procedure in the USA costs only $7,000 in India !!!

Obama should negociate a package deal with India and insurance companies and fly us all over there.

This would certainly work. Now that would be change we can believe in, Yes We Can !

By: Obama The Saint God

Obama The Saint God — Fri, 17 Jul 2009 08:04:01 +0000

Andrew E,

Or we might push for telemedicine outsourced in india.

Hallloooo, this is Kerpal from Hindyia, Vat Arre Yourre medikal problemms ???

HA HA HA, YES WE CAN !!!

By: Obama The Saint God

Obama The Saint God — Fri, 17 Jul 2009 08:01:32 +0000

Obama has no health care problems, there is several physicians and pharmacists following him everywhere he goes and they care for him and his family.

There is a complete pharmacy and facilities in the white house, air force one, the presidential helicopter, camp lejeune etc.

I bet Obama’s health care costs will sky rocket in the next 4 years as he uses up all those facilities at the expense of the taxpayers.

How can he keep a straight face about health care costs when all his health care is covered by us the taxpayers !!!

The rest of us will have to scrape and save and fly to India’s Appollo hospitals to get the same kind of care Obama has !

He could issue plane tickets to all of us, because in India health care is about 10 times less than the USA.

We could outsource health care and this would drastically cut our health care costs.

You should consider this Obama, the future of health care is in Asia, not America.

By: Obama The Saint God

Obama The Saint God — Fri, 17 Jul 2009 07:56:52 +0000

“Cap-and-Trade/Carbon Regulation is a much bigger issue, since it is a sector of the economy that hasn’t yet been regulated. Its also far more insidious. ”

We could decap all the preachy anti-carbon liberals in this country and then trade their carbon offset for a profit. I’m all for that.

After all, those preachy anti-carbon liberals fly in their private jets and power their big mansions telling the rest of us to live like stone age cavemen. They even want us to hold our breath so we won’t expell so much CO2.

One Gore is worth ten thousand average joe’s output of carbon. I hope the man-bear-pig finds him first. He is an inconvenient lying hypocrit.

Ahh Liberals, do as I say, not as I do !

I bet Obama’s health care bill will explode in the next 4 years all at the expense of the taxpayer. I bet he won’t have to wait in line and content himself with third class care.

By: Andrew E

Andrew E — Fri, 17 Jul 2009 07:46:02 +0000

Obama the Saint God writes:

“America will lack doctors…”

No we won’t. We’ll just import them, hastening our descent into a Third World polyglot hellhole. Open borders lives!

By: Obama The Saint God

Obama The Saint God — Fri, 17 Jul 2009 07:31:18 +0000

Prick Bradley,

“Obamacare is just an increase in in an already-existing program.”

Oh, it’s just that ? Phew ! So everybody should be happy and mery go long then.

Hey people, let’s not worry and all be happy and celebrate, because Obama will “just” increase our burdens and loss of freedoms. It’s not that those things are important anyways.

Don’t worry and be happy. Obama will “just” increase the cost of living and “just” increase the erosion of our freedoms and “just” cause more people to die. Let’s all celebrate in joy.

After all like Prick Bradley points out, we are already forced into so many things, so we might as well “just” let Saint Obama force even more burden on us. It’s “just” that folks, nothing to worry about !

You have got to admire “libertarian” logic like Prick Bradley’s.

You’re the best Prick Bradley, Yes We Can !

By: Nick Bradley

Nick Bradley — Fri, 17 Jul 2009 07:09:45 +0000

Obama The Saint God,

Who said that being forced to buy gov’t coverage would make us all happy? Who said I love being forced to do things?

I am forced to buy government services that I don’t want every day. Your over-the-top anger over this one issue is exactly what I’m talking about.

Obamacare is just an increase in in an already-existing program. Right now, you have to be old (Medicare) or poor (Medicaid/SCHIP) to get access to the public option — that access will be expanded. Not much new here.

Cap-and-Trade/Carbon Regulation is a much bigger issue, since it is a sector of the economy that hasn’t yet been regulated. Its also far more insidious. Also, there is absolutely nothing wrong with the current regulatory apparatus for carbon, no possible excuse for intervention.

With health care, you’re moving from a government-ran, highly regulated broken system to a government-ran, highly regulated broken system. The inly difference is that a few coporatist/fascist health care bureaucrats will become government health care bureaucrats.

By: Obama The Saint God

Obama The Saint God — Fri, 17 Jul 2009 06:33:15 +0000

Nick Bradley,

“I cannot believe the level of hyperbole used by opponents of Obamacare. ”

So, being FORCED to buy government sponsored coverage should make us all happy and merry go long ???

You love being FORCED in doing things ? You love being FORCED to depart with yet more of your hard earned money and freedoms ?

We are going to be FORCED ! And that is enough to be furious !

If you love being FORCED so much, give me all your money or else !!!